Took care of a young woman (with a 15 year h/o DM I) recently who presented with DKA. We suspected that cocaine use had precipitated her DKA, but her Hgb A1c >10 also.
On day 3 we were ready to d/c the patient. She protested because her reflux was causing too much pain. She told us that she could hardly swallow water due to the pain. Her oral cavity exam was unremarkable (of course I checked her tonsils). She claimed the pain was most severe.
So what would you do for her. What diagnoses are you considering?
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Some thoughts:
candida esophagitis
HIV with CMV or HSV
retropharyngeal abscess (from cocaine smoking — seen this one myself)
What to do next? I’m a GI and we always have the same diagnostic response to every clinical question, as you know. GERD does not typically cause odynophagia. I would consider Candida, herpes or a pill-induced lesion. Esophageal candidiasis typically associated w/thrush, but exceptions occur. Was an NG tube placed, which may have induced trauma? Esophageal tear?
I’m glad you cleared the tonsils!
I presume that I have struck out on my initial diagnostic considerations and I look forward to public humiliation when you inform us of the correct dx.
eosinophilic esophagitis
Tell her that coke causes ischemic ulcers and there is nothing you can do for her but to protest to the local police department for not winning the war on drugs and Then tell her to follow up with her pcp.
Candida esophagitis
Candida esophagitis
Candida esophagitis
HSV esophagitis
Mucormycosis?